MR imaging prediction of local control of nasopharyngeal carcinoma treated with radiation therapy and chemotherapy

Br J Radiol. 2014 Jul;87(1039):20130657. doi: 10.1259/bjr.20130657. Epub 2014 May 14.

Abstract

Objective: To retrospectively evaluate the association of MRI findings with local control of nasopharyngeal carcinoma (NPC) treated with radiation therapy and chemotherapy (chemoradiotherapy).

Methods: Pre-treatment MRIs of 101 patients (78 males and 23 females, 23-79 years of age) who had NPC treated with chemoradiotherapy were retrospectively reviewed to evaluate tumour involvement of nasopharyngeal anatomic subsites, tumour volume and MRI appearance. Local control rates were evaluated with respect to these MRI findings.

Results: Univariate analysis (using the Kaplan-Meier method) showed that invasion of the skull base as determined by MRI was a significant predictor of local control. In terms of clinical characteristics, T stage and pathological subtype were significant predictors of local control. Multivariate analysis (Cox regression model) of the radiologic findings and clinical characteristics revealed that invasion of the skull base (p = 0.003) and pathological subtype (p < 0.001) were independent prognostic factors for local control.

Conclusion: Invasion of the skull base as determined by MRI predicts the likelihood of local failure and may be helpful in identifying a subset of patients with tumours at risk of local recurrence within 3 years after primary chemoradiotherapy.

Advances in knowledge: It has now become common practice to use MRI for pre-treatment evaluation of patients with NPC. The potential role for MRI findings in predicting local control and prognosis in patients with NPC has implications for treatment planning.

MeSH terms

  • Adult
  • Aged
  • Carcinoma
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nasopharyngeal Carcinoma
  • Nasopharyngeal Neoplasms / drug therapy*
  • Nasopharyngeal Neoplasms / prevention & control
  • Nasopharyngeal Neoplasms / radiotherapy*
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / radiotherapy
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Skull Base Neoplasms / pathology
  • Young Adult